Elizabeth L. McQuaid

Objective: Children from Latino backgrounds face unique challenges in managing asthma. Barriers are compounded when children live in urban settings and are exposed to urban stressors (e.g., barriers to medication use, neighborhood stress). Asthma management in schools is often directly implicated. This study aims to address these gaps in care by developing a 4-session, peer-facilitated, culturally tailored asthma self-management group intervention in urban public-school settings. Methods: We developed and tested the ASMAS (Asthma Self-Management in Schools) intervention, utilizing an iterative process guided by previous work and theoretical models. Feedback from focus groups was used to further tailor ASMAS. We enrolled 81 middle school students in a cross-site pilot randomized controlled trial (RCT) to evaluate the efficacy of ASMAS compared both to Attention Control and No-Treatment Control conditions. Outcomes included asthma control, asthma-related sleep disruption, school absences, asthma self-efficacy, and availability of rescue inhaler and asthma action plan (AAP) at school. Results: Compared to Attention Control participants, youth who received ASMAS had improved asthma outcomes over time (baseline to end-of-treatment) including asthma control (t = 2.1, p<.05, d=.4, M_diff=1.5), asthma-related sleep disruptions (t=-.24, p <.05, d=-.4, M_diff=-3.6), school absences (d=-.2), asthma management self-efficacy (t = 2.3, p <.05, d=.4, M_diff=0.3) and rates of AAP (t = 1.8, p =.06; d=.3, M_diff=20%) and rescue inhalers availability (t = 2.0, p <.01, d=.7, M_diff=23%). Similar patterns were maintained at 4-month follow-up. Conclusions: Results demonstrate ASMAS' feasibility and highlight the potential benefits of the tailored asthma intervention. A full-scale RCT to evaluate ASMAS' effectiveness, implementation, and sustainability is warranted.

Rationale: Clustering of social and environmental risks in low-income neighborhoods is a key factor in racial and ethnic asthma disparities. Integrating school and in-home programs, with treatment tailored to disease risk, is a promising approach for children with high disease burden. Objectives: We evaluated the Rhode Island Asthma Integrated Response (RI-AIR) program in improving asthma outcomes at the individual and community levels. RI-AIR leverages existing community collaborations and technological advances to identify children with asthma at the highest risk for poor outcomes through a system of identification, screening, and intervention. Methods: We conducted a stepped wedge cluster randomized hybrid type II effectiveness–implementation study. School-based catchment areas (N = 32) of high asthma burden were identified using geospatial mapping of asthma-related urgent healthcare use from 2010 through 2018. Families received only school-based interventions if the child’s asthma was categorized as “not well controlled” or school- and home-based interventions if the child’s asthma was deemed “poorly controlled.” Community health workers facilitated communication between families, schools, and healthcare providers. Follow up visits occurred every 3 months to 1 year after the intervention. Results: Individual level: At 3 months, asthma control (primary outcome) improved (d = 0.47; 95% confidence interval, 0.33–0.61) and symptom-free days increased (d = 0.37; 0.24–0.51); both improvements were sustained at 12 months. Community level: healthcare use remained the same or increased (rate ratio, 1.16; 1.00–1.36); however, sensitivity analyses indicated that healthcare use was slightly lower in areas with greater family participation (i.e., penetration; active intervention, 0.93 [0.87–0.99]; postintervention, 0.91 [0.86–0.97]). Conclusions: Intensive, multicomponent interventions and community engagement are needed to improve asthma outcomes in areas of high burden. Clinical trial registered with www.clinicaltrials.gov (NCT 03583814).

Objective: The aim of this scoping review was to identify and describe the community-engaged research (CEnR) methods used in the development and evaluation of psychological interventions for pediatric sickle cell disease (SCD). Methods: We conducted a systematic search of three databases in April 2024 (PubMed, Scopus, and PsycINFO). The review was registered with Open Science Framework (DOI: 10.17605/OSF.IO/956AV). All titles, abstracts, and full texts for papers that appeared to meet criteria were independently reviewed by two members of the research team. Inclusion criteria were pediatric or young adult age and use of CEnR for a psychological SCD intervention. Data were extracted from articles meeting these criteria. Results: The search yielded 235 original articles, of which eight met the inclusion criteria. These articles showed that the involvement levels of community collaborators (patients, families, and community-based organizations) varied across research phases. Notable gaps in the literature were: (1) few studies reported utilizing CEnR methods, (2) variability in language/terms used to describe CEnR methods, (3) limited demographic data about community collaborators, and (4) a lack of description of CEnR frameworks guiding intervention development and evaluation. Conclusions: This scoping review found few studies describing the use of CEnR methods in a way that would facilitate reproducibility. Recommendations include using MeSH CEnR keywords, identifying CEnR methods and frameworks, and including specific information about community when possible (e.g., demographic information, meeting frequency, etc.).

Background: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). Objective: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. Methods: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. Results: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ≥80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ≥80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. Conclusions: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. International Registered Report Identifier (IRRID): PRR1-10.2196/63399

BACKGROUND Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). OBJECTIVE This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. METHODS We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. RESULTS The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ≥80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ≥80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. CONCLUSIONS Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/63399

Objective: Despite a marked increase in the prevalence of pediatric immunoglobulin E-mediated food allergy (FA) in recent decades, there is a dearth of age-appropriate management education and support tools for youth with FA. The purpose of this report is to detail our methods for intervention design and refinement of an interactive educational software program for school-aged children with FA. Method: Development of the “Friends, Family, and Food Application (F3-App)” employed an iterative, user-centered design approach with input from children with FA, their caregivers, and other key experts. Phase 1 (prototype development/pilot evaluation) involved family input on key themes and educational messages, development of a prototype, and pilot testing. Phase 2 (full F3-App development/open trial) included refinement and expansion of the prototype per advisory panel and end-user recommendations, followed by an open trial with additional iterative refinement. Results: Acceptability and credibility of the F3-App were rated highly by most participants. Relatively few technical challenges arose with F3-App installation or use. Follow-up interviews with children and caregivers suggested that the F3-App was generally well received, families found the content useful, and that it prompted family discussion about the child’s FA management. Conclusions: User input is critical to developing family-friendly software to support management of pediatric chronic conditions. Interactive educational software can be a useful channel for children to practice skills and build confidence in disease self-management and to facilitate family communication regarding the stresses of FA management. Implications for Impact Statement: This study describes the development of the Friends, Family, and Food Application (F3-App), with a focus on the community partner-driven design process. The F3-App was credible and highly accepted and recommended by families and promoted family communication around food allergy management. The F3-App that was developed was used in a subsequent randomized, controlled trial.

Objective: Anxiety is among the major psychological concerns for children living with food allergy (FA). Yet research exploring the variables driving anxiety symptoms in FA remains sparse, and most studies still utilize homogeneous samples to assess anxiety symptoms. The current study seeks to evaluate the rates of clinically significant anxiety symptoms among a diverse sample of youth with FA and examine whether a heightened risk perception of FA outcomes and FA burden (vs. FA medical history) is associated with anxiety in youth. Methods: 94 youth ages 10–14 and their parents were recruited from FA clinics at a mid-Atlantic children’s hospital. Both youth and parents completed demographic and FA medical history questionnaires, the Screen for Child Anxiety Related Emotional Disorders, and the Food Allergy Independent Measure as part of a longitudinal study about FA adjustment and adherence. Results: Over a third (37%) of youth scored above clinical cut-offs for overall anxiety symptoms. At least 25% of youth reported clinically significant scores on panic disorder, generalized anxiety, social anxiety, separation anxiety, and school avoidance subscales. Perception of risk of adverse FA outcomes and burden—but not FA medical history–were associated with total anxiety, generalized anxiety, panic disorder, and school avoidance symptoms, but not social anxiety and separation anxiety. Having more FAs was associated with higher social anxiety scores but not with other anxiety subscales. Conclusions: Youth with FA might benefit from psychosocial interventions that address FA risk perception management and promote appropriate FA vigilance to cope with anxiety symptoms.